Only a few cases of K. kristinae infection have been reported in the literature. Patients with short bowel syndrome have an increased risk of opportunistic infections due to decreased bowel immunity and the long-term central venous catheter placement. We report a rare case of K. kristinae infection associated with SBS requiring long-term central venous access port placement.
A 70-year-old woman presented with fever of approximately 39 °C to our hospital for examination. She has undergone total hysterectomy and radiation therapy for cervical cancer 36 years ago. Five years ago, she developed multiple small bowel perforations, and a jejunostomy was constructed at the oral end of the perforation and approximately 110 cm from the ligament of Treitz because of the difficulty in dissecting the adhesion. She developed short bowel syndrome, and the central venous port was constructed four years ago due to poor enteral nutrition. K. kristinae was detected in the central venous catheter tip and in two blood cultures. We administered intravenous vancomycin. After seven days of antibiotic treatment, both fever and inflammatory reaction improved, and the blood culture was negative. After 16 days of antibiotic treatment, we performed central venous port construction on the side opposite to the previous site.
Patients with short bowel syndrome have an increased risk of K. kristinae infections due to decreased bowel immunity and the long-term central venous port, and therefore, these patients should be followed up carefully.
Patients with short bowel syndrome have an increased risk of K. kristinae infections due to decreased bowel immunity and the long-term central venous port, and therefore, these patients should be followed up carefully.Spinal fusion is one of the most common procedure as the treatment of lumbar pathology, this procedure not only stops the progression of spinal pathology, but also immobilizes the painful motion segment. Furthermore, it also stabilizes the spine after neural decompression. However, the increase of mechanical stress and segmental motion at adjacent segments after spinal fusion has been reported regarding to this biomechanical alteration, various pathologies might occur at the adjacent segments, including acceleration of degenerative changes (Chul et al., 2015).
Some patients are afraid to undergo second or next open surgery and prefer to choose other options such us minimally invasive surgery. Here we present management of distal adjacent segment disease using local anesthetic transforaminal foraminotomy and lumbar discectomy. We performed minimally invasive percutaneous endoscopic lumbar discectomy and foraminotomy in an awake and aware 55 years old man under local anesthesia.
The procedure was successful with no complications. There was improvement in VAS and ODI score as quantitative measurement for pain relieve and functional outcome respectively, and the radiologic follow up evaluation shows a stable segment.
The procedure was successful with no complications. There was improvement in VAS and ODI score as quantitative measurement for pain relieve and functional outcome respectively, and the radiologic follow up evaluation shows a stable segment.A "locked" knee is defined as a knee that does not move freely after an injury. Most cases of locked knee are due to intra-articular blockade caused by an unstable meniscal tear, anterior cruciate ligament (ACL) tear, or chondral lesion resulting in a loose limb. In this study, we present a rare case of a locked knee caused by fat pad adhesion CASE PRESENTATION A 23-year-old male presented with a locked right knee, after sustaining an injury falling one month before. Magnetic Resonance Imaging showed loss of ACL feature, normal posterior cruciate ligament, and meniscal tear of posterior horn. Arthroscopy procedure found fat pad adhesion, immobilizing the knee's rotation. After removing all of the fat pad adhesion, the patient's knee could move freely.
Clinical and radiographic examinations are important for early diagnosis of the cause of locked knee, but arthroscopic examination is the gold standard for diagnosis.
Clinical and radiographic examinations are important for early diagnosis of the cause of locked knee, but arthroscopic examination is the gold standard for diagnosis.A 64-year-old lady was diagnosed with having a klatskin type 3A tumor based on imaging, however, an alternative diagnosis was achieved during surgery.
We present a case of a 64-year-old lady who presented for new-onset jaundice and was diagnosed with type 3A klatskin tumor based on MRCP findings. During surgery, it was revealed that the obstruction was caused by a frank intrabiliary hydatid cyst perforation. Choledocoscopy with irrigation, cholangiography, and removal of the mother cyst were performed, and an end-to-end biliary anastomosis over a t-tube was then done. The patient tolerated the intervention and recovered well.
Hydatid cyst disease of the liver usually follows a benign course, however, intrabiliary rupture is one of the common complications associated with this disease. Intrabiliary rupture is classified into either frank or occult. Frank perforation, which is more common, is when hydatid material passes into the biliary ducts, and it may cause biliary obstruction and cholangitis with a high mortality rate. Occult perforation is when the hydatid cyst becomes infected itself, which usually leads to a silent presentation, and may only cause signs of suppuration. Diagnosis is usually achieved by imaging and relevant history. Treatment consists of medical and surgical intervention. Intraoperative cholangiography, choledocoscopy, and t-tube drainage are recommended during surgery for frank rupture.
Intrabiliary hydatid cyst perforation can mimic cholangiocarcinoma and must be considered as an alternative diagnosis in these patients prior to surgery.
Intrabiliary hydatid cyst perforation can mimic cholangiocarcinoma and must be considered as an alternative diagnosis in these patients prior to surgery.Primary rectal choriocarcinoma is an extremely rare malignancy. The association of these neoplasms in patients with inflammatory bowel disease (IBD) has not been reported.
A 34-year-old female with history of Ulcerative Colitis (UC) gave birth to a male fetus. She had postpartum bleeding and high level of beta-human chorionic gonadotropin (βhCG) was detected. Although initial investigations failed to confirm molar pregnancy, abnormal uterine bleeding and high βhCG level necessitate chemotherapy administration. She did not respond to chemotherapy sessions accordingly. Meanwhile, the patient experienced rectorrhagia and colonoscopy revealed a firm submucosal polypoid lesion 8-10 cm from the anal verge. https://www.selleckchem.com/products/ebselen.html The multidisciplinary team candidate the patient for total proctocolectomy and ileal pouch anal anastomosis. Although postoperative course was uneventful and βhCG level dropped but it showed a rising pattern in follow ups. Chemotherapy was planned but there was not suitable response. Unfortunately, the patient passed away 20 months after the initial diagnosis.